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Neoadjuvant treatment of advanced stage esophageal adenocarcinoma increases survival*

2002; Oxford University Press; Volume: 15; Issue: 2 Linguagem: Inglês

10.1046/j.1442-2050.2002.00214.x

1442-2050

T. N. Walsh, M. Grennell, S. Mansoor, Alan Kelly,

Gastric Cancer Management and Outcomes

Sophisticated surgical approaches have a definite but limited role in esophageal cancer. The majority have systemic disease at presentation, minimal residual disease following resection or co-morbid conditions that preclude extensive surgery. This paper examines whether neoadjuvant therapy is effective in advanced-stage disease. A randomized trial, closing September 1995, was followed up to determine results at 5 years. All patients were followed up for more than 5 years. Median survival, based on intention-to-treat, was 17 months for multimodal therapy vs. 12 months for surgery alone (P=0.002). Survival based on treatment received was 27 months vs. 14 months (P=0.0006). Multimodal therapy enhances survival for patients with minimal residual disease. This is consistent with the literature. Under-powered trials cannot prove a real difference to be significant. Future trials should target patients with minimal residual disease.